Treatment Strategy for Acute Type A Aortic Dissection Complicated with Organ Ischemia

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Objective: We report our current treatment strategy for acute type A aortic dissection with organ ischemia as well as notable findings in our experience.Materials and Methods: Among 101 cases of acute type A aortic dissection, 25 had organ ischemia. Malperfusion was assessed at the aorta, proximal portion of the branch, organ parenchyma, and organ function by means of multiple modalities, including transesophageal echocardiography (TEE), near-infrared spectroscopy, and physical examinations. It was assessed every time the perfusion status was altered.Results: There were three operative deaths and one late hospital death. Uncertainty of symptoms and inadequate preoperative assessment in an emergent situation indicated the necessity of an overall check-up of organ ischemia in the operating room on a routine basis. Multi-modality assessment including TEE was helpful for this purpose. Two cases indicated that recovery of a true lumen could be inadequate despite true lumen perfusion including central cannulation. Thrombus in the false lumen appeared to be responsible.Conclusions: To solve practical problems in treating acute type A dissection with organ ischemia, real-time information on organ perfusion is important for detecting the presence of malperfusion, making an appropriate strategy, and immediately assuring the efficacy of the means taken.
日本脈管学会、日本血管外科学会、日本静脈学会の論文